Reduction of Falls and Factors Affecting Falls a Year After Total Knee Arthroplasty in Elderly Patients with Severe Knee Osteoarthritis.

BACKGROUND: Total Knee Arthroplasty (TKA) is a common surgical treatment for severe knee Osteoarthritis (OA), which generally improves pain, physical function, quality of life and possibly fall risk. Fall risk increases for older adults with severe knee OA; however it has not been studied extensively whether this parameter is improved after TKA. OBJECTIVE: To investigate: a) the history and frequency of falls, including mechanism or causes of falls, injuries sustained from falls reported, activity during falling and location of falls and, b) the factors affecting falls, a year after TKA in elderly patients with severe knee OA. PATIENTS AND METHOD: An observational prospective longitudinal study of 68 patients (11 males and 57 females) was conducted. The frequency of falls was recorded every month after knee replacement for a year period. A year after the TKA patients completed self-administered questionnaires (SF-36, Womac, FOF, ABC, PASE) and were assessed in physical performance tests (TUG and BBS). RESULTS: There was significant improvement in falls frequency (p<0.001), differentiation of falling status to the benefit of non fallers (p<0.001) and risk of serious injuries (p<0.001). The factors that affected falling status was history of falls (p<0.0005), fear of falls (p<0.017) and advanced age, marginally (p<0.097). CONCLUSION: TKA generally improved a lot of aspects in patients' life. One of these was the reduction of fall risk, which always co-exists in this population and can cause devastating problems threatening the benefits of the procedure.

Analysis of the chronic lower limb injuries occurrence in step aerobic instructors in relation to their working step class profile: a three year longitudinal prospective study.

BACKGROUND: There is limited information on injury patterns in Step Aerobic Instructors (SAI) who exclusively execute "step" aerobic classes. OBJECTIVE: To record the type and the anatomical position in relation to diagnosis of muscular skeletal injuries in step aerobic instructors. Also, to analyse the days of absence due to chronic injury in relation to weekly working hours, height of the step platform, working experience and working surface and footwear during the step class. METHODS: The Step Aerobic Instructors Injuries Questionnaire was developed, and then validity and reliability indices were calculated. 63 SAI completed the questionnaire. For the statistical analysis of the data, the method used was the analysis of frequencies, the non-parametric test χ^{2} (chi square distribution), correlation and linear and logistic regressions analysis from the SPSS statistical package. RESULTS: 63 SAI reported 115 injuries that required more than 2 days absence from step aerobic classes. The chronic lower extremity injuries were 73.5%, with the leg pain, the anterior knee pain, the plantar tendinopathy and the Achilles tendinopathy being most common overuse syndromes. The working hours, the platform height, the years of aerobic dance seem to affect the days of absence due to chronic lower limb injury occurrence in SAI.

[Differential diagnosis of back pain in patients with ankylosing spondylitis: instable cervical spine fracture]. / Differenzialdiagnose Rückenschmerz bei Patienten mit Spondylitis ankylosans: instabile Halswirbelsäulenfraktur.

HISTORY AND ADMISSION FINDINGS: A 65-year-old patient with longstanding ankylosing spondylitis (AS) complained of persistent pain in the right shoulder and the neck; elevation of the shoulder was impaired. The symptoms had started a week before admission after a fall. Physical examination revealed generally decreased mobility of an already hyperkyphotic cervical spine (CS) and decreased thoracic excursion. The paravertebral muscles were stiff . CLINICAL INVESTIGATIONS: Because of the trauma extensive imaging procedures with conventional radiographs, magnetic resonance imaging (MRI) and computed tomography (CT) of the CS were performed. These showed a compression fracture of C5, detachment of the dorsal and ventral ligaments and a ventral dislocation of C4 with dislocation (Type C fracture). TREATMENT AND COURSE: After immediate consultation of the cooperating center for spinal surgery corpectomy of C5 and ventral fusion of C3-7 were performed on the same day, together with a dorsal transpedicular fusion. During the imaging procedures symptoms of a beginning paraplegia occurred. After successful surgery and early postoperative rehabilitation, the patient was discharged to an in-patient rehabiltation unit. At discharge, there was but a slight paresis of the right arm. CONCLUSION: Patients with AS and advanced spinal ankylosis are at increased risk of vertebral fracture after minor accidents. Regardless of the initial report of clinical symptoms it is mandatory to perform appropriate imaging procedures usually including MRI.

Proprioception and functional deficits of partial meniscectomized knees.

BACKGROUND: The partial meniscectomy leads to proprioceptive knee deficits in a short period after the arthroscopic procedure; however, to our knowledge, a limited number of studies have investigated the long-term outcomes of partial meniscectomy on the knee joint proprioception. AIM: The aim of the present study was to assess the proprioception and muscle function of the partial meniscectomized knee through balance and functional tests 1-2 years posterior to arthroscopic surgery. DESIGN: This was an observational study. SETTING: Partially meniscectomized persons after 1-2 years. POPULATION: Twenty-six male patients who had an arthroscopic partial meniscectomy at the age between 20-40. METHODS: All patients performed balance (Biodex Stability System and balance boards) and functional (triple jump) tests. On the balance system the deviations from the horizontal plane were recorded, on the balance boards their performance was timed, and on the functional test triple jump their performance was recorded in meters. RESULTS: One-way Anova was used to determine significant differences between the healthy and injured limb. The level of statistical significance was set at p<0.05. The results revealed significant differences (p<0.05) between the healthy and injured limb at all balance and functional tests performed. CONCLUSION: The present study demonstrated that 1-2 years after partial meniscectomy, patients had reduced proprioception and knee muscular ability in the operated leg compared to the non-operated leg. Clinical rehabilitation impact. Proprioception and knee muscular ability deficits significantly affect objective knee function, indicating the importance not only of the restoring muscle function but also of the proprioception ability in partial meniscectomy patients.

[Arthritis of the atlanto-axial joint with inflammatory neck pain as a primary manifestation of seronegative rheumatoid arthritis]. / Atlantoaxiale Arthritis mit entzündlichem Nackenschmerz als Erstmanifestation einer seronegativen rheumatoiden Arthritis.

HISTORY AND ADMISSION FINDINGS: A 68-year-old woman with known degenerative joint disease suffered from increasing neck pain. Physical examination revealed painfully restricted movement of the cervical spine. INVESTIGATIONS: Erythrocyte sedimentation rate and C-reactive protein were increased. Tests for rheumatoid factors, antinuclear, anti-citrullinated protein and anti-neutrophil cytoplasmic antibody were negative. Cervical spine x-ray showed osteochondrosis with partially bridging spondylosis at C5/C6, but there was no atlanto-axial dislocation. Magnetic resonance imaging (MRI) revealed bone marrow edema and hyperintensity of the odontoid process, but there were no indications of fissures or fracture lines. TREATMENT AND COURSE: These findings indicated seronegative rheumatoid arthritis, with predominantly active atlanto-axial arthritis. After methotrexate and prednisolone had been administered the symptoms improved rapidly and inflammatory parameters returned to normal. Three months later no atlanto-axial arthritis was seen at MRI. CONCLUSION: Rheumatoid arthritis involving the atlanto-axial region should be considered in patients with persisting neck pain and signs of inflammation.

A new full-endoscopic technique for cervical posterior foraminotomy in the treatment of lateral disc herniations using 6.9-mm endoscopes: prospective 2-year results of 87 patients.

Anterior cervical decompression and fusion (ACDF) is the standard procedure for operation of cervical disc herniations with radicular arm pain. Mobility-preserving posterior foraminotomy is the most common alternative in the case of a lateral localization of the pathology. Despite good clinical results, problems may arise due to traumatization of the access. Endoscopic techniques are considered standard in many areas, since they may offer advantages in surgical technique and rehabilitation. These days, all disc herniations of the lumbar spine can be operated in a full-endoscopic technique. The objective of this prospective study was to examine the technical possibilities of full-endoscopic posterior foraminotomy in the treatment of cervical lateral disc herniations. 87 patients were followed for 2 years. The results show that 87.4% no longer have arm pain and 9.2% have only occasional pain. The decompression results were equal to those of conventional procedures. The operation-related traumatization was reduced. The recurrence rate was 3.4%. No serious surgical complications occurred. The recorded results show that the full-endoscopic posterior foraminotomy is a sufficient and safe supplement and alternative to conventional procedures when the indication criteria are fulfilled. At the same time, it offers the advantages of a minimally invasive intervention.

Soccer players' muscular imbalances: restoration with an isokinetic strength training program.

The aim of the study was to investigate the effect of a muscular training program on soccer players' performance which initially appeared imbalanced or bilaterally asymmetrical. During the preparation period, 35 soccer players performed an isokinetic measurement of knee flexors and extensors (60 degrees(-1) and 180 degrees sec.(-1)). 15 of these had muscular imbalances or deficits and followed a specific isokinetic training program for 2 mo., 3 times per week. After the completion of the isokinetic training program, the 35 players underwent the same isokinetic test. Significant differences were noted between the pre- and posttraining measures at both angular velocities in peak torque values, in differences from one limb to the other, and in peak torque ratios for flexors and extensors. Consequently, the application of this specific isokinetic training program can restore imbalances in knee muscle strength efficiently.

Measurements and evaluations in low back pain patients.

With the present review of literature, the authors intended to compare the definition terms, selection criteria, and measurement tools or methods used in different studies related to chronic low back pain (CLBP) patients. The relevance of including all the above information is that any health-care professional can use them to evaluate their treatment methods with CLBP patients or use them in study designs according to their objectives. These measurements concern pain measurements, measures that were used to describe the CLBP pain, questionnaires used to measure the CLBP patients' responses to pain, the pain effects on their living activities, and also measurements of the physical abilities and functional performance. A computerized literature search in English MEDLINE was conducted using "low back pain," and "flexibility, "strength,""evaluation,""functional level," and "measurements" as search words. Identified abstracts were scanned, and useful articles were acquired for further review. Interms of CLBP definitions, the authors concluded that is best defined as a lumbar, sacral, or lumbosacral spinal pain that is continuous or essentially continuous but low level punctuated by exacerbations of pain, each of which is characterized as "acute." In order to establish the criteria for selecting participants in a study design related to CLBP, pain characteristics and clinical diagnoses have to be taken into consideration for obtaining homogeneity of groups. Finally, the selection of measurement tools and evaluation methods is related to the study's goals, the specialization of the researchers, and their validity.

A New full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6-mm endoscopes: prospective 2-year results of 331 patients.

Even with good results, conventional disc operations may result in consecutive damage due to traumatisation. Endoscopic techniques have become the standard in many areas because of the advantages they offer in surgical technique and in rehabilitation. The transforaminal operation is the most common full-endoscopic procedure in surgery of the lumbar spine. It is frequently necessary to reach the spinal canal directly in order to achieve sufficient resection of lumbar disc herniations. Even in using a lateral approach, the authors recognise the clear limitations of the transforaminal procedure. The objective of this prospective study was to examine the technical possibility of a full-endoscopic interlaminar access. The focus was on questions of sufficient decompression, as well as advantages and disadvantages of the minimally invasive procedure. 331 patients were followed for 2 years. The results show that 82 % reported no longer having leg pain, and 13 % had only occasional pain. The decompression results are equivalent to those of conventional procedures. Traumatisation of both the access pathway and the spinal canal structures was reduced. Epidural scarring was minimised. The recurrence rate was 2.4 %. No serious surgical complications were observed. The authors view the technique described, which offers the advantage of a truly minimally invasive procedure, as a sufficient and safe alternative to conventional procedures, when the appropriate indication criteria are heeded. There are technical problems because of the small instruments. In conjunction with the transforaminal procedure, this is an expansion of the spectrum for full-endoscopic surgery of lumbar disc herniations.

The effects of soccer training and timing of balance training on balance ability.

The purpose of the present study was to investigate the effects of a soccer training session on the balance ability of the players and assess whether the effectiveness of a balance program is affected by its performance before or after the regular soccer training. Thirty-nine soccer players were randomly divided into three subject groups (n=13 each), one control group (C group), one training group that followed a balance program (12 weeks, 3 times per week, 20 min per session) before the regular soccer training (TxB group), and one training group that performed the same balance program after the soccer training (TxA group). Standard testing balance boards and the Biodex Stability System were used to assess balance ability in the C, TxB, and TxA groups at baseline (T0) and after completing the balance program (T12). The same tests and additional isokinetic knee joint moment measurements were carried out in the TxB and TxA groups pre- and post-soccer training. Two main results were obtained: (1) No differences (p>0.05) were found in balance ability and knee joint moment production between pre- and post-soccer training. (2) The balance program increased (p<0.01) the balance ability in the TxB and TxA groups, and the improvement in the TxA group was greater (p<0.05) than that in the TxB group post-soccer training. Result (1) is in contrast to the notion of a link between fatigue induced by a soccer training session or game and injury caused by impaired balance, and result (2) has implications for athletic training and rehabilitation.

Resistance training effects on muscular strength of elderly are related to intensity and gender.

The purpose of this study was to determine whether a high intensity (HI) versus a moderate (MI) or low-intensity (LI) training program would be more effective in improving the isokinetic knee extension muscular performance in healthy inactive men and women. Sixty-four participants, men and women, were randomly assigned to one of four groups: control group (C), LI (50% of 1RM), the MI group (70% of 1RM) and the HI (90% of 1RM). Participants exercised on three resistance exercise machines: leg extension, leg curls and leg press. The isokinetic testing method (concentric mode) applied prior to and at the end of the training period (16 weeks, three 3 times per week) to assess the knee muscular performance. MANOVA repeated measures revealed that the HI group demonstrated the most strength gains following a speed specificity pattern (most considerable improvement occurred at or near slow speeds from 7.3% to 11.2% for male and from 2.3% to 15.2% for female). In addition, males demonstrated a greater improvement of knee extension power output than females. In conclusion, HI strength training is proposed for elderly men and women as the most effective protocol. Furthermore only at low-velocity testing, women of the HI showed a greater change than men (p < 0.05). Regarding strength increase in relation to various testing velocities, a greater increase was found in HI at low velocities, with the other training groups exhibiting almost similar strength increase at all tested speeds.

Therapy of ankylosing spondylitis--a review. Part I: Conventional medical treatment and surgical therapy.

The main outcome parameters in AS and other SpA are pain, disease activity, function, spinal mobility, and structural progression. There are several treatment options, which differ, depending on the localization and severity of the manifestation and the degree of structural changes already present. There is a basic role for physiotherapy to improve and maintain spinal mobility and function and prevent handicap. The basis for drug therapy in AS is NSAIDs, which may also have an influence on structural progression. DMARDs are mainly used in cases with peripheral arthritis. Corticosteroids have a clear role for intra-articular therapy, while the role for systemic use is, in contrast to RA, mainly reserved for subgroups. It is largely unclear whether long-term spinal progression can be prevented by conventional drug therapy. Treatment with biologics such as anti-TNF-alpha therapy is discussed in Part 2 of this review. To be published in the next issue of the Scandinavian Journal of Rheumatology. Surgical treatment of the spine is indicated in cases of severe instability pain, in cases of deformity endangering the patient in daily life by the limited range of vision, and in patients with neurological deficiency. AS-specific problems are spinal fractures and atlantoaxial instability, which need careful management including surgery. Joint replacement therapy is established and beneficial for AS-disturbed joints of the hip and knee.

Resistance training in older women: effect on vertical jump and functional performance.

AIM: Few studies have determined the effects of a heavy resistance training on vertical jump performance in older adults. The purpose of the present study was to evaluate the effects of a 12 week heavy resistance training in vertical jump and functional performance in healthy, inactive, older women. METHODS: Seventeen sedentary older women (aged 53-69 years) were assigned either to a control (C, n=8), or to a heavy resistance training (RT, n=9). The RT group trained knee extensors and flexors at 80% of 1-repetition maximum (1-RM), 3 days per week for 12 weeks. Both groups were evaluated in 1-RM lower body strength, squat jump (SJ) and countermovement jump (CMJ) height, and chair rising time, before and after the training period. RESULTS: After the training period, RT significantly improved (P<0.001) the 1-RM lower body strength, SJ, CMJ height, and chair rising by 68.9%, 24.5%, 21.7%, and 13%, respectively. Significant correlations were observed among the percent (%) change in 1-RM lower body strength and SJ (r=0.849, P<0.001), CMJ height (r=0.797, P<0.001), and chair rising time (r=-0.917, P<0.001). CONCLUSIONS: Muscle power improved after a short-term heavy resistance training, as measured by vertical jump and chair rising performance, in inactive older adults. The gains in muscle strength may contribute to the gains in chair rising time, SJ and CMJ height.

Effective ways of restoring muscular imbalances of the rotator cuff muscle group: a comparative study of various training methods.

BACKGROUND: Many studies have compared different training methods for improving muscular performance, but more investigations need to be directed to the restoration of muscular imbalances. OBJECTIVE: To determine the most effective training for altering strength ratios in the shoulder rotator cuff. METHODS: Forty eight physical education students were randomly assigned to four groups (12 per group): (a) experimental group who carried out multijoint dynamic resistance training for shoulder internal and external rotation movement (pull ups or lat pull downs, overhead press, reverse pull ups, push ups) (MJDR group); (b) experimental group who exercised the same muscle group using dumbbells weighing 2 kg (isolated group); (c) experimental group who followed an isokinetic strengthening programme for the rotator cuff muscle group (isokinetic group); (d) control group who had no strength training. Testing was performed in the supine position with the glenohumeral joint in 90 degrees of abduction in the coronal plane, with a range of motion of 0-90 degrees of external rotation and 0-65 degrees of internal rotation at angular velocities of 60, 120, and 180 degrees /s. The test procedure was performed before and after the exercise period of six weeks. RESULTS: One way analysis of variance found no differences between the groups for the initial tests. Analysis of variance with repeated measures showed that the strength ratios in all the experimental groups had altered after the exercise period, with the isokinetic group showing the most significant improvement. CONCLUSIONS: Isokinetic strengthening is the most effective method of altering strength ratios of the rotator cuff muscle.

Endoscopic surgery of the lumbar epidural space (epiduroscopy): results of therapeutic intervention in 93 patients.

Determination and therapy of the underlying pathology in chronic pain syndrome in the lumbar spine is frequently difficult. Minimally invasive and microsurgical techniques may offer advantages. Epiduroscopy is available for visualization of the lumbar epidural space. 93 patients with chronic back-leg pain syndrome were epiduroscopically operated. When findings were appropriate, mechanical instruments and the holmium:YAG laser were applied therapeutically. 45.9 % of these patients presented with positive results in postoperative examination. Pathomorphological processes corresponding to the multifactorial pain processes, which escape detection in modern imaging procedures, can be diagnosed in the epidural space using epiduroscopy Therapeutic intervention is basically possible. However, use is limited due to technical difficulties. Navigation of the endoscope is especially limited in access via the hiatus sacralis.

[Spinal cord stimulation (SCS) using an 8-pole electrode and double-electrode system as minimally invasive therapy of the post-discotomy and post-fusion syndrome--prospective study results in 34 patients]. / Spinal-Cord-Stimulation (SCS) mittels 8-poligem Elektroden- und Doppelelektroden-System als minimalinvasive Therapie beim Postdiskotomie- und Postfusionssyndrom - Prospektive Studienergebnisse von 34 Patienten.

AIM: Therapy of a pronounced post-discotomy (PDS) and post-fusion syndrome (PFS) is often unsatisfactory because of the complexity and multifactorial pain genesis. If surgical interventions cannot promise relief and if the entire interdisciplinary spectrum of conservative treatment measures is inadequate, the area of neuromodulative procedures offers spinal cord stimulation (SCS). The objective of this study was to examine the therapeutic possibilities of SCS using an 8-pole electrode and double electrode system in PDS and PFS with extensive back-leg pain areas. METHOD: An appropriate SCS system was implanted in 34 patients with PDS and PFS. Follow-up examinations were made prospectively over a period of 24 months using general criteria and psychometric test measuring instruments validated for German-language use. RESULTS: An 8-pole double electrode system was implanted 23 times, a single electrode sufficed in 11 cases. The area of pain was covered in all patients. This required special technical capabilities of the SCS system. The results remained constant over 24 months. The morphine dose could be reduced by at least 50 %. All measuring instruments confirmed a clear reduction in pain and improvement in quality of life as a result of SCS implantation. CONCLUSION: The SCS is an minimally invasive surgical procedure which can enlarge the therapeutical possibilities of pronounced PDS and PFS resistant to other modes of treatment. Special technical possibilities of parameter setting are required to cover the pain areas.

Application of holmium:YAG laser in epiduroscopy: extended practicabilities in the treatment of chronic back pain syndrome.

OBJECTIVE: Minimally invasive and endoscopic techniques offer advantages in the treatment of chronic back pain syndrome and may provide for expanded indications and visualization. Epiduroscopy for the visualization of the epidural space still is burdened with technical problems. The mechanical instruments now available, coupled with the narrow working canal, result in marked limitations. The aim of this study was to assess the possibilities and technical requisites for the use of the holmium:YAG laser in lumbar epiduroscopy. BACKGROUND DATA: Epiduroscopy has been used for visualization of the lumbar epidural space since the 1930s. Studies have been performed to evaluate the effects and possibilities of epiduroscopy in chronic back pain. Most of them only describe the anatomical aspects. MATERIALS AND METHODS: Forty-seven patients were epiduroscopied and treated, for findings of corresponding epidural adhesions, with the holmium:YAG laser. The examinations concentrated on the general applicability of the holmium:YAG laser in epiduroscopy and the technical parameters necessary for this procedure. The clinical evaluation of therapy was made prospectively in comparison with the preoperative status and compared to already recorded groups in previous studies. RESULTS: Bending behavior without negative impact of the epiduroscope was only attained with laser fibers less than 300 microm, so a fiber with a diameter of 265 microm was used as the standard. The minimum energy output of the laser required for an adequate ablative effect was 0.8 J at a frequency of 8 Hz. The total energy output was 0.256-1.4 kJ. Complications did not occur intraoperatively nor following the procedure. The follow-up examinations showed no deterioration of the complaints in any patient. There was no occurrence of relevant laser-related edemas or adhesions. The proportion of painful conditions that could be positively influenced corresponded to that in a control group treated only by mechanical means. CONCLUSION: The results show that the holmium:YAG laser considerably expands therapeutic possibilities and aids in solving the technical problems of epiduroscopy. No negative effects occurred when the laser is used.

[Epiduroscopic diagnosis and treatment of epidural adhesions in chronic back pain syndrome of patients with previous surgical treatment: first results of 31 interventions]. / Epiduroskopische Diagnostik und Therapie epiduraler Adhäsionen beim chronisch lumbalen Schmerzsyndrom des voroperierten Patienten: Erste Ergebnisse von 26 Interventionen.

AIM: Scars in the epidural space play an important role in the chronic lumbar pain syndrome of patients with previous surgical treatment. The results of surgical resection are frequently unsatisfactory. Discrepancies to imaging diagnostics are conspicuous. These are known from experience with endoscopic operations. Minimal adhesions may promote pain. Epiduroscopy is available for visualization of the epidural space. The objective of this study was to examine its possibilities in patients with previous surgical treatment. METHOD: 31 patients with chronic lumbar pain syndrome who had previously received surgical treatment were operated epiduroscopically. Mechanical instruments and the holmium:YAG laser were used for epidural adhesion. RESULTS: All patients showed adhesions. 24 patients also presented with adhesions on the contralateral side. There were marked discrepancies between imaging and intraoperative findings. The use of mechanical instruments was limited. The use of laser fibers resulted in greater possibilities. Back pain could be better influenced than leg pain. The procedure was limited by still-existing technical problems. CONCLUSION: Epiduroscopy offers a novel view of this compartment. Minimal adhesions which are not visible in imaging ean promote pain. They can be partially diagnosed and treated by epiduroscopy. There are still marked limitations to epiduroscopy due to technical problems. These must be minimized.

Injuries in artistic gymnastic elite adolescent male and female athletes.

OBJECTIVES: The purpose of this study was to record the incidence of Sport Injuries (acute and overuse syndromes) in Greek artistic gymnasts in relation to sex, age, event and exercise phase. METHODS: 187 Greek elite artistic gymnastic athletes (100 male and 87 female athletes) participating in Greek artistic gymnastic championship involving all age-related categories, were observed on a weekly basis for a year. The athletes consisted of the pre-national team that was chosen to prepare for the next Olympic games. RESULTS: 147 (61.5%)acute injuries and 93 (38.5%) overuse syndromes were recorded. The most common anatomical location of injury was the ankle (110 cases, 46%), followed by the knee (63 cases, 26.2%). According to the results, the rate which involved mild injuries was 26.8% (64 cases, 34 males, 30 females) moderate injuries was 44% (106 cases, 59 males, 48 females), major injuries was 29% (70 cases, 38 males, 31 females). For the total sport injuries recorded, the injury incidence on the "floor" and especially during "landing phase", were statistically significant. CONCLUSIONS: Artistic gymnastics predisposes to acute injuries, by its nature, but up to 70% are mild and moderate. Special attention needs to be given during "floor exercises", especially on landing phase.